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Patient & Family Education Materials

Central venous catheter: Care at home

What is a central venous catheter?

A central venous catheter is a thin tube inserted into a large vein that goes to the heart. The type your child has is a:

___ Broviac catheter

___ Hickman catheter

___ MEDCOMP catheter

___ One lumen

___ Two lumen

___ other:

The catheter will be used to give your child IV medicines or fluids and take blood samples. This means fewer needle pokes and less pain.

How should I prepare my child?

Use simple words to explain why the catheter is needed and what to expect. Remind your child that the tube means less pain. How much detail you give will depend on the age of your child, and the degree of anxiety about the procedure. If you need help, ask a nurse or Child Life staff member.

Explain procedures before they are done, especially what your child will see, hear, and feel. Tell your child what is expected ahead of time, such as, "Your job is to hold still while I change the dressing." This will help make care at home easier for both of you.

How is the catheter put in?

During surgery, the surgeon inserts the tip of the catheter under the chest skin and tunnels it into the superior vena cava, a large vein that goes to the heart. The catheter comes out at the nipple line or slightly below. There will be two small incisions on the chest after surgery, one where the catheter was inserted into the vein, and one where it comes out of the chest skin (the "exit site"). Your child may have soreness or discomfort at the incision sites. Pain medicine will be given as needed.

What is the catheter like?

The part of the catheter under the skin has a small dacron cuff. Tissue grows into this cuff area. The cuff acts as an anchor to help prevent movement of the catheter. This process takes at least two weeks or more. There is no dacron cuff in the MEDCOMP catheter.

The part of the catheter outside the skin has a plastic end with screw-like threads. An injection cap is on the end of the catheter so that it does not leak or allow air or bacteria in. It also allows you to inject medicines or flush solution into the catheter without removing the cap.

There are different kinds of catheters. Some have just one tube (single lumen), while others have two separate tubes within the same catheter (double lumen). If your child has a double lumen catheter, each tube must be treated separately.

How should I care for my child?

Caring for a child with a central venous catheter may be a little scary at first. The nurses will take care of the catheter and give the medicines while your child is in the hospital. As your child improves and is able to be at home, you may be taught how to give medicine through the catheter. Home care nurses will teach you and help you become comfortable with the procedures before you do them yourself. These are the special things that need to be done:

preventing infection

changing the dressing

flushing the catheter

giving the medicine

changing the injection cap

solving problems

knowing when and who to call for help

Preventing infection

It is very important to prevent infection, which might require removal of the catheter. The nurse will show you how to keep your supplies sterile, so no germs will enter the catheter and cause an infection.

Preventing infection in the hospital:

Central venous catheters are helpful for taking care of your child; however, they can increase the risk of infections when bacteria grow in the catheter and travel to the bloodstream. This is called a Central Line Associated Blood Stream Infection or CLABSI. A CLABSI can be serious and life threatening.

Members of your health care team take steps to keep infections from happening during your stay in the hospital. Parents and patients also have a role to play in preventing CLABSIs:

Wash your hands with soap and water, or use alcohol-based hand rub found in each room. Hand hygiene is required:

When you enter and leave your child's room.

Before and after you prepare food, eat, or feed your child.

Before and after you use the bathroom or change a diaper.

Ask your child's visitors to wash their hands when they enter and exit your child's room.

Do not allow visitors to touch the catheter or tubing.

Watch your nurses and doctors to make sure they wash their hands before and after handling the central line. Do not be afraid to remind them to wash their hands!

Keep the central line and IV tubing out of the diaper area when changing the diaper, and do not allow your child to suck on the catheter or the tubing.

Preventing infection at home:

Cleanliness is a must! Each time you do a procedure with the catheter, follow these steps:

Prepare a clean work area by cleaning a solid surface with a disinfectant cleanser (such as Lysol® or another brand).

Wash your hands well, using one of the following methods:

Use an alcohol-based hand sanitizer (Purell® or another brand) according to directions.

If alchohol-based sanitizer is not available, wash your hands with antibacterial soap for at least 15 seconds, rubbing all surfaces briskly, including between your fingers and under your fingernails. Use a paper towel or clean hand towel to dry your hands, and then use the towel to turn off the faucet.

Before each time you flush or put any medicine into the IV tubing, put on non- sterile glves and scrub the injection cap for 30 seconds with a fresh chlorhexidine wipe, using friction. Let it dry. Do not fan or blow on it.

How do I order supplies?

Your supplies will be ordered from a medical equipment supply company or home care pharmacy. The first order will be delivered to the hospital or your home. Check with your nurse to be sure you have everything you need. You will receive the number to call when you need to order supplies in the future.

Note: Normal saline and heparin solution can be used until the expiration date for only your child. Throw a syringe away sooner if you see sediment in it or question its cleanliness. If you do throw a medicine away, be sure to call the home care pharmacy for a replacement dose.

When flushing the catheter you must use 10-ml or larger syringes. A smaller syringe may push too much pressure into the catheter and cause it to burst.

Pre-filled syringes have an air bubble in them. Before using, hold syringe upright pull back slightly on the plunger and squirt air bubble out.

Can my child bathe/shower?

Yes, after the stitches are out and exit site is healed, your child can shower or bathe in shallow water, if you cover the site and catheter with a waterproof dressing. If the transparent dressing becomes wet, replace it right way.

Do not let the catheter drop down into the bath water, as germs from the water may enter the end of the catheter. Bathing in hot tubs should be avoided.

Can my child go swimming?

Yes, after the stitches are out and the exit site is healed, your child may swim in a chlorinated pool, but cover the catheter with a waterproof dressing and then change the dressing and injection cap immediately afterward and clean the outside of the catheter. Swimming in lakes, rivers and oceans is not recommended due to the risk of infection. Please discuss with your child's provider for details.

Changing the dressing

How often should the dressing be changed?

The dressing over the exit site should be changed once a week (every 7 days), or any time it becomes loose, soiled, or wet.

Should I wear gloves when I change the dressing?

Yes. Wash your hands and put on non-sterile gloves to remove the old dressing. Wash your hands and put on sterile gloves for cleaning the skin around the catheter and applying the new dressing.

How do I change the dressing?

Prepare the work area.

Wash your hands well.

Gather supplies:

BioPatch® with transparent dressing, Tegaderm CHG®

skin prep

chlorhexidine applicator (2)

chlorhexidine wipes (2)

sterile gauze

non-sterile gloves

sterile gloves

sterile drape (2)

masks (3)

non-sterile saline (if using Tegaderm CHG® to assist in removal)

cotton swabs (sterile), if needed

tape, 1-inch wide___ You may have a dressing kit with the above supplies in it.

Open sterile drape. Only touch the outside edges to keep the middle section sterile.

Open supplies onto sterile drape without touching any of the items inside the packages or touching the packagesto the sterile drape.

Cover supplies on sterile drape with the second sterile drape. Do not touch the side of the sterile drape that will be in contact with the sterile supplies. Only touch the outside edges to keep the middle section sterile.

Put on non-sterile gloves and mask. Masks should be worn by you, your child and helper.

Remove the old dressing without pulling on or touching the catheter near the exit site.

BioPatch® will stick to the transparent dressing when removed

Tegaderm CHG® - loosen the edges of the transparent dressing and then apply a small amount of normal saline onto the CHG square to loose in and then remove.

After old dressing is removed. Take off non-sterile gloves and wash hands.

Put on sterile gloves. After sterile gloves are on, only touch supplies on your sterile drape.

Visually check the skin around the exit site for redness, swelling, or drainage.

If there is drainage at the exit site, clean it off with an extra chlorhexidine applicator.

Prepare the sepps, applicator, or swab as directed.

Scrub the site with one chlorhexidine applicator for 30 seconds, using friction in a back and forth pattern, up and down, sideways, and diagonal pattern. Allow skin to completely dry (approx. 60 seconds) do not blow on or fan the area.

Clean the catheter:

Hold a chlorhexidine wipe around the catheter at the exite site to prevent puling.

Use another chlorhexidine wipe to clean the catheter. Put is around the catheter at the exit site and work it toward the injection cap.

Always hold the catheter with gauze or chlorhexidine wipe to keep the line and hands sterile.

Apply skin prep where the edges of the dressing will be. This protects the skin.

If using BioPatch®, place it around the catheter with the white side in contact with the skin and blue side up. Put the slit where the catheter will lie, once it is secured with dressing.

Coil the catheter if possible. Double lumen catheters are shorter and sometimes cannot be coiled.

Apply Tegaderm CHG® (with CHG square directly over the exit site of the catheter) OR transparent dressing if using BioPatch®

Apply tape:

Place a 1-inch-wide by 2-3 inch long piece of tape under the catheter at the edge of the transparent dressing.

Place a 1-inch-wide by 2-3 inch long piece of tape over the catheter on top of the previously place piece of tape.

Flushing the catheter with heparin

When should I flush the catheter?

The catheter must be flushed to help prevent blood from clotting and blocking it. If the catheter becomes blocked, it may have to be removed.

When IV fluids are running through the catheter, it is being flushed continuously. When the catheter is capped off between uses, it must be flushed with heparin, a medicine that prevents clotting. Flush it at these times:

after infusing medicines or fluids.

after drawing blood.

at least every 24 hours.

How do I flush the catheter?

Every time you flush the port with normal saline or heparin, use the "push-and-pause" method: push a little solution, then pause for 1 to 2 seconds, then push a little more, pause, and so on. This method cleans the inside of the catheter. Your home care nurse will show you how to do it.

Normal saline and heparin syringes are good until the expiration date. Throw it away sooner if you see sediment in it or if you question its cleanliness. If you throw one away be sure to call the home care pharmacy for a replacement.

Quick ReferencePreparing pre-filled syringes:

ALL pre-filled syringes have an air bubble in them (normal saline, heparin, medicine). Remove the tip cover from the syringe and point the syringe upward, pull slightly back on plunger and squirt the air bubble out before using.

Put on non-sterile gloves.

Scrub injection cap with a chlorhexidine wipe for 30 seconds and let it dry.

Disposal varies depending on the area you live in. Some communities have a household sharps collection program. To find out what you should do, check with your garbage collection company, pharmacy, or clinic.

Changing the injection cap

When do I need to change the injection cap?

To prevent infections, change the injection cap as recommended:

___ every 4 days if your child is receiving infusions

___ after 7 days without infusions

How do I change the injection cap?

Plan to change the cap at a time when you will be flushing the catheter with heparin.

Prepare the work area.

Wash your hands well.

Gather the equipment:

chlorhexidine wipes (2)

injection cap (1 for each lumen)

sterile gauze (2 for each lumen)

sterile drape

sterile gloves

mask (3)

sterile normal saline syringe (1 for each lumen

heparin syringe (1 for each lumen)

Clamp the catheter (each lumen).

Open sterile drape. Only touch the outside edges to keep the middle section sterile.

Open supplies onto sterile drape without touching any of the items inside the packages or touching the packages to the sterile drape.

Put on mask. Masks should be worn by you, your child, and helper.

Put on sterile gloves. After sterile gloves are on, only touch supplies on your sterile drape.

Prepare injection cap. Attach injection cap to sterile normal saline syringe and point them upward to flush the injection cap and remove air in cap.

If double lumen, prepare two separate injection caps, each with a sterile normal saline syringe.

Using one piece of gauze pick up the catheter while maintaining hand sterility.

Scrub the connection site (where the old cap joins the catheter) with a chlorhexidine wipe for 30 seconds, using friction. Let it dry.

Pick up new piece of gauze and use it to unscrew the old cap from catheter and remove it.

Inspect catheter hub threads (grooves).

If NO debris or blood noted, continue onto step 15 and do NOT scrub the catheter hub threads (grooves).

If visible debris or blood noted, with a new chlorhexidine wipe scrub the catheter hub threads (grooves) for 30 seconds, using friction. Let it dry. Do not touch the end of the hub.

Screw on the new cap. Do not touch the end that screws into the catheter. If you do, throw the cap away and use a new one.

Unclamp the catheter.

If double lumen, use a piece of gauze to unclamp catheter to keep hand sterile.

Flush the catheter with sterile normal saline and remove syringe.

If double lumen, repeat steps 11-17.

Scrub injection cap with a new chlorhexidine wipe for 30 seconds and let it dry.

Attach heparin syringe tip into the injection cap and flush using the push- and-pause method. When syringe is empty, remove it from the injection cap.

Clamp the catheter.

If double lumen, repeat steps 19-21.

Solving problems

Problem

Possible cause

What to do

Fever, chills

Tenderness, redness or pus at the catheter site

Infection

Check your child's temperature.

Call the doctor right away.

Trouble flushing the catheter

Unable to give medicine or fluid into catheter

Catheter may be clamped.

Catheter or tubing may be kinked.

Unclamp it.

Remove the kink.

If the catheter is not kinked or clamped, do no force the solution into the tube. Call the home care nurse to report the problem.

Fluid leaking from the catheter

Injection cap is not screwed on securely.

Tighten the cap.

If you see a leak in the catheter, clamp it (or fold it over and pinch it) between the damaged area and the skin and call your home care nurse, clinic or emergency room right away.

Missing injection cap

Injection cap became loose and fell off

Replace the injection cap using sterile technique and scrub the catheter hub threads (grooves) prior to replacing the injection cap, even if no debris or blood is noted.

Skin redness where the tape or dressing was

Sensitivity to tape or dressing

You may need to change the dressing size or the type of tape or dressing used.

Catheter accidentally comes out

Hold firm pressure over the site for at least 5 minutes.

Apply antibacterial ointment and cover it with gauze and tape.

Call your doctor or home care nurse.

Emergency kit

Take an emergency kit with you everywhere you take your child. Be sure to check the kit before you leave home and replace any used supplies when you return home so it is always ready to go. Supplies include:

This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit www.childrensmn.org/educationmaterials.